GI neoplasms part 2: esophageal, gastric and biliary-mcgowan Flashcards
who is more likely to get esophageal cancer
Men>Women (4:1) - new cases and deaths
what is included in esophageal cancer
gastroesophageal junction (GEJ) and 5cm into the stomach
what is the most common esophageal cancer
adenocarcinoma = most secondary to Barretts
where in the world in SCC the more prevalent esophageal cancer
asia and sub-saharan africa
what is the later findings of esophageal cancers (presentation)
dysphagia (progressive over weeks to months)
weight loss
+/- odynophagia, heart burn, dyspepsia, bleeding, coughing, pneumonia, chest/mediastinal/back pain, hoarseness, lymphadenopathy
what is the test of choice for esophageal cancer
EDG with biopsy - establishes diagnosis
what tests are completed after diagnosis of esophageal cancer is confirmed
CBC to check for anemia
LFTs to check AST, ALT and alk phos
CT of check, abdomen, pelvis - look for regional spread
PET CT for distal spread
Endoscopic US - assess depth of tumor and nodes
+/- FNA of any possibly involved nodes
what is the treatment for localized esophageal cancer
endoscopic resection or esophagectomy
what is the treatment of localized esophageal cancer with lymph nodes involved
chemo and/or radiation, then esophagectomy + lymphnodeectomy
what is the treatment for distant spread esophageal cancer
palliative tx with chemo and or radiation
esophageal stending
local brachytherapy
jujunostomy or gastrostomy tube for nutrition
what are the prevention methods for esophageal ccancer
no routine screening
monitor/follow up for Barretts esophagus
encourage lifestyle modifications
NSAIDs may be protective
Anti-acid medications may be protective
what are risk factors for gastric cancer
H/pylori infection/gastritis strongest overall risk factor
pernicious anemia, hx partial gastric resection, smoking, high nitrate/salt diets, low vitamin C diet, hereditary tumor syndromes
what is the most common type of gastric cancer
adenocarcinoma
proximal - secondary to metaplasia
distal - secondary to H. pylori infection
what is intestival gastric cancer
more common
metaplasia of glandular structures
H. pyloria - atrophic gastritis - metaplasia - dysplasia - CA
what is diffuse gastric cancer
poorly differentiated, less glandular
less related to h.pylori, mor ehereditary
what are the different morphologies of gastric cancer
fungating
poylpoid
ulcerating
diffusely spreading
superficial spreading
what is the later symptoms of gastric CA
dyspepsia
early satiety
epigastric pain
anorexia
weight loss
+/- signs of UGI bleeding, post prandial vomiting, dysphagia
what is virchow node
palpable left supraclavicular lymph node
what is sister mary joseph nodule
umbilical nodule
what is the test of choice for gastric cancer
EGD with biopsy
-age 55+ with new epigastric symptoms, persistent dyspepsia, often with barium swallow
what further tests are completed once gastric cancer is confirmed
EUS for depth and spread, CT C/A/P, PET for distal mets
what is the treatment of localized gastric CA
laparoscopic or open gastrectomy (either total or subtotal) + lymphadenectomy
need vit B12 supplemental after gastrectomy
preop chemo and/or radiation improves survival
what is the treatment of advanced (non-locally resectable) gastric cancer disease
palliative treatment
what is cholangiocarcinoma
carcinoma of the gallbladder itself or the bile duct
what are risk factors for GB cancer
cholelithiasis
salmonella typhii infection
gallbladder polyps
calcification of the gallbladder (porcelain gallbladder)
genetics (K-ras and P52 mutations)
what are risk factors for cholangiocarcinoma
bile duct adenomas
ulcerativ colitis
primary sclerosing cholangitis
biliary cirrhosis
DM
hyperthyroidism
chronic pancreatitis
ETOH - heavy consumption
smoking
HIV/HCV
NAFLD/cirrhosis
obesity
helmith infection of bile ducts (SE Asia)
what can reduce the risk of all types of bile duct cancer
ASA and statin
what can reduce the risk of intra-hepatic cholangiocarcinoma
metformin
what is the presentation of biliary A
progressive jaundice signaling obstruction
RUQ abdominal pain
anorexia and weight loss
+/- fever and chills, hematemesis or melena, pruritis and skin excoriations
what is seen on PE with biliary CA
jaundice (in severe dz)
palpable gallbladder
Hepatomegaly (tender)
+/- ascites
what is the Courvoisier sign
palpable nontender GB + obstructive jaundice
*suggests malignancy
what is the laboratory workup of biliary CA
elevated conjugated (indirect) bilirubin
+/- elevated alk phos and cholesterol
AST normal to mildly elevated
Elevated CA19-9 (tumor marker)
what is the test of choice for biliary CA
MRI with magnetic resonance cholangiopancreatography (MRCP)
what is the benefit of MRCP
visualization of entire biliary tree
defines extent of involvement
elucidates any vascular involvement
what is the treatment of biliary CA
mainstay = surgery
-young and fit: cholecystectomy
if sx not an option - palliative tx
